Provider Demographics
NPI:1033799226
Name:PUBLIC SAFETY CRISIS SOLUTIONS
Entity Type:Organization
Organization Name:PUBLIC SAFETY CRISIS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:RAMELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:602-466-9456
Mailing Address - Street 1:809 W MARYLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1325
Mailing Address - Country:US
Mailing Address - Phone:602-466-9456
Mailing Address - Fax:
Practice Address - Street 1:809 W MARYLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1325
Practice Address - Country:US
Practice Address - Phone:602-466-9456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1134761661Medicaid